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LETTER

Diabetes Distress and Illness Perceptions in Tunisian Type 2 Diabetes Patients [Letter]

, ORCID Icon, & ORCID Icon
Pages 3869-3870 | Received 15 Nov 2023, Accepted 23 Nov 2023, Published online: 30 Nov 2023

Dear editor

The article with the title “Diabetes Distress and Illness Perceptions in Tunisian Type 2 Diabetes Patients” attracted our attention because it produces a nomogram prediction model for diabetes distress (DD) and illness perceptions in type 2 diabetes mellitus patients which can be used to predict weaknesses in self-management and psychological distress.Citation1 This nomogram involves four factors (economic income, age at diagnosis, comorbid illness, and HbA1C status) which were obtained from the result of analysis. In the initial stage of analysis there were six significant risk factors for DD and illness perception, but in the final stage there were only four significant factors. Meanwhile, factors that were not significant were marital status and insulin. Is it true that these last two factors have no effect on DD or illness perception? Could these factors have an indirect influence?

Researchers used a logistic regression test to analyze the significance of DD and illness perception factors, so that indirect effects could not be detected, because this test assumes that all factors have a direct influence.Citation2 If we suspect that insulin conditions have an indirect influence, then we have to go through intermediate variables, for example comorbidities. So first insulin affects comorbidities and then comorbidities affect DD and illness perception.

Therefore, we recommend that further analysis be carried out to prove the existence of indirect effects from the six factors. In this case, the method that can be used is path-analysis. Because researchers use nominal scale data, one program that can be used is Smart-PLS.Citation3–5 We hope that the results of this advanced analysis provide more accurate information for future improvements to the predictive model.

Disclosure

The authors report no conflicts of interest in this communication.

References

  • Masmoudi R, Hadj Kacem F, Bouattour M, et al. Diabetes distress and illness perceptions in tunisian type 2 diabetes patients. Diabetes Metab Syndr Obes. 2023;16:3547–3556. doi:10.2147/DMSO.S430001
  • Buis ML. Direct and indirect effects in a logit model. Stata J. 2010;10(1):11–29. doi:10.1177/1536867X1001000104
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